Related Experiment Video
Updated: May 28, 2025
Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles
Published on: July 26, 2024
Relationship Among Fragility Fractures and the Overall Cardiovascular Burden in Endogenous Cushing Syndrome
Giacomo Voltan1,2, Pierluigi Mazzeo1,2, Michele Cannito1,2
1Department of Medicine DIMED, Endocrine Unit, University of Padova, 35128 Padua, Italy.
Insights
Fragility fractures are common in Cushing syndrome (CS). Atherosclerosis and osteoporosis are key predictors, highlighting the link between cardiovascular health and bone fragility in CS patients.
Area of Science:
- Endocrinology
- Bone Metabolism
- Cardiovascular Disease
Background:
- Cushing syndrome (CS) is associated with significant cardiovascular morbidity and a high prevalence of fragility fractures.
- Bone mineral density (BMD) and trabecular bone score (TBS) have limitations in predicting fracture risk in CS.
- Reliable predictors for fragility fractures in CS remain largely unidentified.
Purpose of the Study:
- To determine the prevalence of fragility fractures in patients with endogenous CS.
- To identify potential predictors of fragility fractures in this patient population.
Main Methods:
- A retrospective, cross-sectional study involving 51 patients with overt CS.
- Evaluated biochemical markers, BMD, TBS, fracture history, body composition, and arterial intima-media thickness (IMT).
Main Results:
- Fragility fractures were present in 62.7% of patients at diagnosis.
- Fracture group showed lower spine T-score, longer disease duration, higher waist circumference, and increased serum uric acid, IMT, and prevalence of venous thromboembolism and atherosclerotic plaques.
- Atherosclerosis and osteoporosis were identified as independent predictors of fractures.
Conclusions:
- Cushing syndrome patients with a higher burden of cardiovascular morbidity are more susceptible to fragility fractures.
- Identifying atherosclerosis and osteoporosis is crucial for managing fracture risk in CS.
Context:
Patients with endogenous Cushing syndrome (CS), in addition to significant cardiovascular morbidity, are burdened by a high prevalence of fragility fractures. Bone mineral density (BMD) alone poorly predicts the risk of fracture, and the implementation of trabecular bone score (TBS) is supported only by scant evidence. Indeed, reliable predictors of fractures in endogenous CS are still lacking.
Objective:
This work aimed to analyze the prevalence and the potential predictors of fragility fractures in our patients with CS.
Methods:
A monocentric, retrospective, cross-sectional study. A total of 51 patients with overt CS were enrolled. Main outcome measures included biochemical evaluation, BMD measurement, TBS evaluation, fracture presence, body composition evaluation, and arterial intima-media thickness (IMT) assessment.
Results:
Fragility fractures were found in 62.7% of patients at diagnosis. Fractured patients exhibited lower spine T-score (P = .03), longer disease duration (P = .025), higher waist circumference (P = .006), and predominantly male sex (P = .008). Increased serum uric acid levels (P = .001), greater IMT (P = .017), and higher prevalence of venous thromboembolism events (31.3% vs 5.3%, P = .037) and atherosclerotic plaques (47% vs 5.3%, P = .002) were described in the fracture group.Multivariable logistic regression identified the presence of atherosclerosis (OR 13.35; 95% CI 1.154-154.34, P = .038) and osteoporosis (OR 11.30; 95% CI 1.55-82.56, P = .017) as independent predictors. TBS values were inversely correlated with body mass index, fat and lean mass, and serum uric acid, and positively correlated with high-density lipoprotein cholesterol.
Conclusion:
CS patients with higher overall burden of cardiovascular morbidity are more prone to experience fragility fractures.
More Related Videos
09:02Cortical Bone Assessment Using Ultrasonic Guided Waves: A Reproducibility Study in a Healthy Population
Published on: January 31, 2025
05:55Author Spotlight: Developing a Rat Model for Weight-Bearing Intervention to Investigate Osteonecrosis of the Femoral Head
Published on: September 27, 2024
Related Concept Videos
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:24Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:27Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...